右心室中位间隔与心尖部起搏有效性对比的随机对照研究

Comparison of effectiveness of right ventricular mid-septal pacing vs apical pacing: a randomized controlled trials

目的比较右心室中位间隔部起搏(RVMSP)与右心室心尖部起搏(RVAP)对起搏器依赖患者临床及血流动力学的影响。方法因Ⅲ度或高度房室传导阻滞植入永久起搏器患者96例,随机分为RVMSP组(50例)和RVAP组(46例)。术后6个月和12个月进行随访,测定起搏阈值、阻抗、左心室射血分数、心室同步性指标、生活质量评分、6分钟步行试验及N末端—脑钠肽前体等指标。结果术后6个月随访,RVAP组和RVMSP组患者起搏阈值、阻抗、左心室射血分数、心室同步性指标及临床预后指标差异无统计学意义(P>0.05);术后12个月随访,RVAP组较RVMSP组左心室射血分数轻度降低(P>0.05),左心室内径及容积扩大(P<0.05),心室收缩同步性指标较差(P<0.05);两组临床预后指标差异均无统计学意义(P>0.05)。结论 RVMSP比RVAP更有利于双心室收缩同步性,增加心室射血分数,可作为RVAP的替代起搏位点。

Objective The aim of the present study was to evaluate the differences in clinical and hemodynam- ic results between conventional right ventricular apical pacing （RVAP） and right ventricular mid-septal pacing （RVMSP） in pacemaker-dependent patients. Methods Ninety-six patients with Ⅲ degree or higher-grade atrio- ventricular block were randomly allocated to RVMSP （n=50） and RVAP （n=46）. Threshold and impedance, echocardiographic LVEF, ventricular dyssynchrony features, and distance during a 6-min walk test （6MWT） and Minnesota Living with Heart Failure Questionnaire （mlHFQ） were determined at 6 and 12 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） were mea- sured. Results After 6 months of follow-up, no statistically significant differences in echocardiographic and clinical/biologic features werefound between two groups. Compared to the RVMSP after 12 months of follow- up, The RVAP group had a trend toward a worse left ventricular ejection fraction （P=0.17）, had more intraven- tricular dyssynchrony （P=0.03）, and the large diameter and volume of left ventricular （P 〈 0.05）. There were no statistically significant differences in clinical features between two groups. Conclusion RVMSP was associ- ated with decreased dyssynchrony and better left ventricular ejection fraction compared to the RVAP. RVMSPcould represent an alternative pacing site in place of RVAP.